Potential Role of Nrf2 Activators with Dual Antiviral and Anti-Inflammatory Properties in the Management of Viral Pneumonia

Chih-Yin Lin,1 Chun-An Yao2 1Department of Neurology, Chang Gung Memorial Hospital, Linkou 333, Taiwan; 2Department of Dermatology, Cathay General Hospital, Taipei, TaiwanCorrespondence: Chun-An YaoDepartment of Dermatology, Cathay General Hospital, 280 Renai Road Sec. 4, Taipei, TaiwanTel +886-2-27082121Fax +886-2-2709-6521Email chunany115@gmail.comAbstract: The outbreak of coronavirus disease 2019 (COVID-19) pandemic has already caused a huge burden to the global healthcare system, with the death toll reached tens of thousands. Although some antiviral agents were identified and used to inhibit viral replication, the management of cytokine storm is also a critical issue. In this article, we reviewed the literature on drug candidates for severe acute respiratory syndrome (SARS-CoV-1) and provided a brief overview of a class of drugs that exert antiviral and anti-inflammatory effects. These molecules mitigated inflammatory cytokine cascades induced by viral infections via Nrf2 activating capacity and might have additional anti-fibrotic and anti-remodeling properties. Besides, their effects on the regulation of scavenger receptors expression by macrophages may offer some benefits to the pulmonary antibacterial defense system after viral infection. The potential roles of these agents assessed on the basis of the pathophysiology of viral pneumonia and acute respiratory distress syndrome were also discussed. Further research is needed to ascertain whether Nrf2 activators are useful in the management of viral pneumonia.Keywords: COVID-19, viral pneumonia, Nrf2 activators, curcumin, sulforaphane, macrolide